Building Doctors Who Can Fix Healthcare

Welcome to Med Evidence, where we help you navigate the truth behind medical research with unbiased evidence-proven facts hosted by cardiologist and top medical researcher Dr. Michael Koren. Hi, this is Mitch Rothstein with Med Evidence and today I have the privilege of being joined by Dr. John Shufeldt and thank you for joining us, Dr. Shufeldt. And I wanted to tell everybody a little bit about your background so they know the kind of expertise that you bring to the table on some of the topics that we'll talk about. Uh Dr. Shufeldt got his medical degree from Chicago Medical School in '86. He did his emergency medicine residency at Christ Hospital uh and served as chief resident there. He got then an MBA from Arizona State University in '95 and then followed that with a JD from Arizona State in 2005. His first venture into the entrepreneurial world was in 1993 when he founded the NextCare, an urgent care facility program that he expanded from one to 60 facilities and exited as the CEO in 2010. At which time he started one of the first of its kind telehealth programs called MeMD and that connected 500 medical and mental health providers across all 50 states. And that was sold to Walmart in 2021. In 2015, he started Tribal Health uh which is after witnessing some of the disparities in healthcare delivery, especially in indigenous lands, um became a vehicle for improving that delivery system. And then in 2021, he entered the venture capitalist world starting Accelerant Ventures uh, specifically looking at helping healthcare startups. Uh he Uh, in 2025 he co-founded Vivamed Biopharma, a drug development company which currently is, um, looking at, from what I read, 150 molecules. Is Is that correct? And most importantly from my aspect, in 2025 he also, uh, made a donation to the Arizona State Medical School uh, and, um, helped them ex pand their program to that which now involves not only, uh, growing physicians with medical backgrounds, but also with engineering backgrounds, specifically AI. Uh, do I have that right, John? Did I And, uh, one of the things I was interested in and, uh, had was a little bit of difficulty kind of, uh, sussing out the the kind of aspects of it. When I apply to your medical school now, uh, it It does it take me 4 years to come out with an MD and a medical and engineering degree? Cuz I had a difficult time with just the medical part of it. I can't imagine adding on anything more. It does. You get a masters in engineering and then an MD, a doctorate in in medicine, uh, in 4 years. And So, they're buying programs. And did that require rehashing the entire curriculum of the medical school? It does. They have very team-based reverse classroom learning. So, they're they're little these 10-person classrooms with a computer whiteboard, eight students, a PhD and an MD, and then they go after it. And they combine engineering and medicine in the same coursework. Um, and so they look at very systems-based approach to fixing the healthcare system, but they also look at very structural things in the body, uh, on both an engineering and medical perspective. And when you say reverse, you said reverse learning, what what what does that mean to me? Well, so back in the day Dr. Chapple stood up on the board on a blackboard and drew, you probably remember, um, drew the femoral triangle in multi-colored chalk. Now, I'm not an artist and I couldn't reproduce that if my someone held a gun to my head. And it'd be like, "Oh my god." because you had Frank Netter's textbook. Those days are over. Now there's small classrooms where the students basically teach the MD and the PhD their topic for the day. And so their topic for this last week was basically an immunology topic where they had to go in and do a deep dive in the immunology and they spend all day every day, um, going through these problems, uh, that they suss out and they're basically they get presented with patients and they go very deep into the diagnosis, the treatment, the pathophysiology behind it, the microbiology, and everything related to it, the biochemistry, everything related to the project, to the to whatever disease state they're looking at. And then the engineering aspects that are applicable. And that that starts year one, day one. Day one, yep. Yeah, cuz as I remember, and I'm sure you do also, in medical school the clinical part really didn't start till your third year when you started to interact with patients in the first couple of years was very didactic kind of book learning. And uh, that sounds like it uh, gives them a leg up. And in some of the articles that I I've read that you're looking to help develop uh, physician entrepreneurs and through this kind of combination of the engineering and the medical um, background, how how do you think that helps prepare people better to kind of change things going forward? Well, I think the students are really geared Many of the students are already engineers. They already have their bachelor's in engineering. Um, you know, there's also, um, history major and English major in the class as well. But they're really trained to look at healthcare not only as a patient in front of them uh and there's a very strong humanities aspect of the curriculum as well. But not only as a patient in front of them, but the systems around the patient. How do they get there? How's healthcare delivery affected by them? How do they affect healthcare delivery? So, it's really more of a global perspective and not just created another set of physicians, but physicians who are going to really change the system. And um a a strong part of the program, obviously, involves AI. And as you know in the community right now, there's a lot of concern about privacy issues with AI and uh people are concerned about it and there's been some uh dents in the uh mantle of integrity of the medical community itself looking at kind of how things uh back looking at how things were handled during COVID. Um are there things that we should be doing now individually or as an industry to help make have the community understand how this is not going to put them at their privacy at jeopardy and how it's going to help them. I mean, the data security is obviously incredibly important for a myriad of reasons. And so, I think my people myself included and I think I'm pretty pretty adept at this, still gets almost clickbaited into things and still has to be cognizant like, oh my god, do I really need three levels of security here? Um and so, yeah, I think the we have to be just a higher level of awareness with these deep fakes, particularly now with the with the gender of nature of AI and the voice fake and the video fake. Um it's interesting. We're looking at the company that right now with Accelerant um that uses radar to analyze someone's voice to make sure it's the actual person talking and and not an AI and not an AI model of their voice. So, more and more is coming to try to subvert the male people with male intent. And that that will obviously increase the security of the system overall and as AI will eventually, I guess, become the gatekeeper of that data pathway for all patients, right? Correct. So, that that's a uh I think something that we still need to kind of assure the community that, you know, we have control of this even though we've got some of these AI systems kind of invading other AI systems during their test planning, but it'll be something that'll obviously change over the next couple of years. It will evolve. I I I told you, Ray, will evolve over time. Yeah. It's um looking looking at the your kind of uh pathway and your development of the entrepreneurial aspects of medicine, was that something that you knew while you were in medical school that you just didn't want to be, you know, an ER doc doing your, you know, 25 shifts a month and that you wanted to do something broader than that even while you were in medical school or did that come in kind of during your clinical experience in the real world or how did that happen? I mean, I was entrepreneurial since I was a little kid. I made candles and sold them door-to-door and made chocolate and sold them door-to-door. So, I was always kind of that entrepreneurial spirit. In medical school, I worked on an ambulance. I ran the student note service where we distributed notes in the class to all the other students in the class. Um so, I always had that kind of mindset. My the problem I have is I see something and then I go, "Well, I'm not the sharpest tack in the box. I can't be the one who I can't be the only one seeing this. Someone else had to figure this out." And then I'll go research them. like, god darn it, no one else figured it out. So, I'm like, all right, well, I guess it's me. And that's how urgent care started. I was, you know, seeing patient after patient that didn't need to be in the emergency department. And I went, I you know, I did I did I did the knife and gun club ED residency, which is white. And seeing the UTIs and sore throats is totally fine, but that's not what I trained to do. Well, we got to get these people out of here. Where can they go? Well, let's go to an urgent care. And this was before the days of NPs and PAs. Few PAs around, but it was all physician-driven. And so, we opened our first urgent care in '93, and no one knew what urgent care was. Uh we had to convince the plans that we were something, convince the patients. And now, you know, you can't spit without hitting an urgent care, but in '93, people thought this was the craziest thing in the world. Yeah, completely changed the landscape. How did staying on that topic, though, as a newly minted ER doc, or relatively newly minted ER doc, that required, I'm sure, a lot of organizational skill and a lot of financing to kind of start an urgent care center and then to grow it. How how did you organize those aspects of it in terms of the organizational people for the infrastructure and then the financing? Well, I would like to say that it was all well thought out and well planned and just went super smooth like a rocket ship. None of that would be true. It was trial and error. It was mistake after mistake. It was triple mortgaging my house and, you know, having the having the nurse manager embezzle $80,000. And I mean, just the stories go on and on, and they're laughable now. You know, there's that Søren Kierkegaard quote, "Life can only be understood backwards, but has to be lived forward." And I look back and where I am today, I'm like, oh, it makes total sense. There's this pathway here, and it one follows the other, but going forward, it was just, you know, throwing stuff at the wall. So, it wasn't a straight It wasn't a straight walk from one to 60 centers. There were some ups and downs along the way. There there was the uh more than more than some. But, you know, looking back, it you know, it's all the old saying that success is stumbling from failure to failure with no loss of enthusiasm. Um you know, I'm the eternal optimist and very enthusiastic. So, although there were a lot of nights I talked to the ceiling fan at 3:00 a.m. Um and it never really responded back to me. Um I would do it all again in a second because the you know, it's not the it's it's always a journey, not the destination. Yeah. Well, I It's a It just from reading your bio, it has been a have a quite a journey. And I I abbreviated it because I wanted some time to talk to you during the time that we had together. So, now now you're entering the the kind of venture capitalist marketplace and you're looking at new bio startups. When When you look at a company and you're evaluating a company now, are there certain things that you that hit you and you say, you know, yeah, that's something I want to be part of? Is Is it mostly product or company culture? Or when you do your evaluations, what are the kind of the main points that you hit looking at companies? I mean, we look at things that are non-consensual What I try to do is find things that are non-consensual and right. And what I mean by that is things that that when someone tells you them, you're like, huh? This person's either crazy, they're out of their mind, or they may be onto something. And I personally had a few of those. Mostly, I've been crazy, but a couple times that's like, wow, that actually made some sense. Um and got market validation. So, we look for things that are non-consensual and right. We look for people trying to solve problems that are expensive to solve, difficult to solve, repetitive, and that have a decent moat around them, so no one else can just jump in and and try to solve them as well. And we find a significant amount of those, but we also see a significant amount of people with these crazy cool solutions. But when you drill down to it, say, "Okay, this is cool, but what problem are you trying to solve?" And the problem might be really small or very personal to them, which is great. Go for it. This is not a This is not a business opportunity for us. And the other thing we look for, and this I have a I'm still having an internal dialogue with. I always look for, you know, I look for founders who are coachable. They They demonstrate humility. They treat others with kindness. All the things we like in humans. However, then that's And that's the um um that's the kind of the construct I use. However, you know, what I've invested in Elon Musk, what I've invested in Steve Jobs, and Mark Zuckerberg who shows up late, and Steve Jobs who's un-showered in flip-flops, I probably wouldn't have, but that would have been a mistake. So, this whole pattern recognition thing that I have going on in my head, I'm like, "Oh my gosh, I've got pattern recognition cuz I've been a founder." Maybe entirely BS. It may not be the way to look at it. So, that that's been the that's been the internal dialogue. Well, I it it's interesting that I enjoyed your comments about founders and funders. And I place myself in the second category primarily as I write along funder. But currently right now, um what do you think as you see the landscape in health care from your perspective, where are the areas of biggest need for innovation and change in terms of whether it's in terms of either therapy or in terms of health care delivery or in terms of reimbursement, what do you see the landscape of medicine doing over the next decade? It It's It's clearly not going to stay the way it is now. Nor nor should it. I mean, anybody who's been a patient or provider, and I'm sure you have those two. I probably have calls three to five times a week, "Can you help me, John, navigate something? I've got my friend has this issue. I have this issue. My child has this issue, and I'm getting nowhere." So, fortunately, I'm old and have gray hair and met some people who are best-in-class, and I can call you up and say, "Hey, I needed the best sleep medicine specialist. Who do I go to?" And you can say, "Oh, you know 10 of them off the you know off in your off the back of your hand." So, we need to figure out a better way to bring the right patient to the right provider at the right time who makes the right diagnosis for the right price. And I think we're close. Um and that's going to involve everything from AI to genomics to epigenetics to pharmacogenetics, making sure the patient's treated with the right medication, who can metabolize a medication, and then treating these people in real time. So, that's that I think is the big area for oppor- big area of opportunity. The challenge is going to be figuring out how to work with the health plans. And I've had a flip in this. I mean, I'm a capitalist and then some. However, this ain't working. And so, you look at the you know the health plan CEO salaries and the multiple multiple layers of people trying to figure out a way that the patients don't get care from the from the physicians and ways to pay physicians less. That's That That That can't be sustainable. And so, I'm actually migrating toward a single-payer health system. And even though I don't know if Canada or the UK has figured it out, I think we can. And it probably won't be in my lifetime, but something does have to change. And uh if you migrate to that kind of system, that you obviously have a set amount of money per patient per year. Do you think that has a downstream effect on reducing the entrepreneurial aspects of medicine that we're kind of currently moving forward off of the kind of fringes of private health care system? Well, it's it's certainly not the health plans generally. I mean, some of the health plans have venture capital arms, but it's certainly not the health plans generally that are driving the need for more effective more better technology. It's I believe physicians and other health care people immersed in the system who are saying like I, this this has to change because this doesn't work. And maybe it's a very personal experience. Or maybe if we're a physician, it's just the things that he or she see every day that just grinds them and and their colleagues down. And so we see a lot of that. On the drug development side, using AI, we've reformulated a lot of medications that are on the patent cliff and use them and focus them towards the biomarker of the disease and not the disease itself because as you know, two people with asthma, me and a 20-year-old woman, probably have a different root cause for our wheezing. And it may be a biomarker cause. We need to trace we need to direct our care towards the our treatment towards the biomarker not towards the symptoms. So that's how that's how we're approaching that. And that's a very sophisticated AI model. Yeah. Yeah, I think you know, compared to uh uh hanging theophylline drips back in the day uh without uh you know, even an automated IV where we were counting drops per minute uh things have come a long way in the last 40 years. So uh that's really um uh uh quite a quite a telling statement. And um I I did want to uh before we close, again congratulate you on uh the medical school and this whole idea of kind of changing the way we're approaching medicine from the beginning of the training period, which is when we really need to do it. Otherwise, you get kind of concrete thinkers, which a lot of people in my age group were because that's the way we were trained and didn't really have Well, our energy was really kind of devoted to doing the way we did things and not really looking outward towards the way we could be doing things. So, is there is there one particular aspect right now that you would like to see if you could change tomorrow? And I know health care delivery is primarily what your interest is, but other than health care delivery, what would the next thing that be in terms of the health care industry that you would like to see change? Is Is the From your aspect and your legal training, is the regulation overwhelming at this point? Is it too much or too little or is that something we should be tinkering with or I mean, I it takes quite a while to get drugs to market, and that's changing. I think the FDA is changing as well, so I'm less concerned about that. I think after spending so much time and and indigenous lands treating, you know, um Native Americans, there's a huge huge health care disparity between what what what we in the zip code who won the zip code lottery think is good health care and those who live in indigenous who were forced to live in indigenous lands. Um that has to change. That's unfair that they've been treated unfairly for 400 years. And I think if a anybody goes out there and witnesses how folks live. I mean, they're incredibly gracious and thoughtful and and wonderful people, but boy, if you stacked up all the odds they have against them, most of us would just crumble. They're They're resilient as hell, but now's the time to right that wrong and fix the healthcare disparities among all the other disparities that they're faced that they face. I'd fix that. Yeah, well, that is well said. And and John, if people want to learn more about the John Shufeldt School of Medicine and medical medical engineering, what should they do? Your website or how should they get a hold of you? Um certainly the the Southern Adventist website. Certainly that is it. LinkedIn works as well. I try to be responsive to both. And then I'll So yeah, either way works. That's great. And I can't tell you how much I appreciate your time. Of all the busy people, I don't know if I've ever met anybody busier. So I've never worked a day in my life. I've never worked a day in my life. It's been It's been a blast. Well, thank you. And thank you for taking the time to speak with me. Pleasure is mine. Thank you. Thanks for joining the Med Evidence podcast. To learn more, head over to medevidence.com or subscribe to our podcast on your favorite podcast platform.